2 weeks Ago By Nathan Friedland, Special to Montreal Gazette
Article content During my six years as a nurse in an emergency room, where many of my patients were elderly and nearing the end of their lives, palliative care meant “comfort care only.” In other words, we were to try to manage pain and other symptoms without invasive interventions. Palliative patients could receive narcotics or other drugs for comfort but were not eligible for CPR or intubation, for example.
Many moral injuries later, where I felt I could not provide proper comfort care to these patients, I was fortunate enough to get hired at a palliative care residence in the West Island. After getting through the six month probationary period, I continue to learn that high-quality palliative care — to which every Quebecer is entitled — is far more than “comfort care only.” Not only have I learned about specialized medications delivered by syringe drivers to control symptoms like pain and anxiety, I’ve also seen that there’s a great deal of living done near the end of life.
I’ve seen a husband meet his goal of walking down the hallway holding his wife’s hand, and a father repairing a fractured relationship with his son. I’ve been privileged to see patients make fantastic paintings, and help them get out of bed so they could enjoy a beautiful summer’s day on the terrasse. I’ve heard remarkable stories about patients’ lives.
One told me: “You’ve given me back my dignity.” I’ve seen friends gather in the dining room to celebrate patients’ birthdays, and I’m learning how to discuss end-of-life issues in a positive way with award-winning courses like LEAP (learning Essential Approaches to Palliative Care) . Yes, the majority of patients die in the residence, but their deaths are dignified with rituals that are respectful and honourable.
Each patient who dies is put on a stretcher draped with a handmade quilt and is slowly escorted out of the residence by nurses, PABs, social workers and volunteer staff. A candle is lit and placed in a small, individual lantern in the lobby that burns for 24 hours in honour and remembrance. Each time I accompany a patient out, I try to recall all those patients who did not get the opportunity to receive this kind of palliative care and whom I saw die in the hospital.
There were many. Quebec has been forging ahead with medical assistance in dying for patients. As of Oct.
30, it became the first province to allow a person with a serious and incurable illness, such as Alzheimer’s disease, to request that MAID be administered months or even years in the future — when their condition leaves them unable to consent to the procedure. The Health Department says it is confident it will be ready to meet the expected demand, noting it will take time for the first requests to be approved, giving the health system further room to prepare. But has the government devoted the same energy toward providing high-quality palliative care to patients as an end-of-life option? From all I’ve seen, the answer, sadly, appears to be no.
Similarly, health-care professionals may offer MAID to patients as a way to give them relief of suffering, but it seems to me palliative care is not discussed as a viable option to the degree it should be in a caring and empathetic society. With the population of seniors rapidly rising in Quebec, now is the time to engage in serious discussions about options for end-of-life care. While MAID is one viable alternative, high-quality palliative care is another — and must be included in a serious way in doctor-patient conversations.
I, for one, would like to see health-care providers and government officials send the message through their words and actions that there is, indeed, a great deal of living to be done at the end of life. Nathan Friedland has been a nurse for 20 years and works at a palliative care residence in the West Island. He lives in Roxboro.
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